Most traumatic brain injuries suffered by children are mild and do not lead to hospital admission, at least in one large urban area.

Action Points

Explain that most traumatic brain injuries suffered by children are mild and do not lead to hospital admission.

Point out that children 4 and younger had the highest incidence, and those 5 to 9 had the lowest, with rates rising again for older children.

Most traumatic brain injuries suffered by children are mild and do not lead to hospital admission, at least in one large urban area.

In Seattle and its suburbs, only about 3% of traumatic brain injuries were moderate, severe or fatal, according to Thomas Koepsell, MD, of the University of Washington in Seattle, and colleagues.

And overall, the rate of traumatic brain injury in the region was more than 300 per 100,000 child-years, Koepsell and colleagues reported online in Pediatrics.

The findings are based on data on medically treated injuries collected during an 18-month period of surveillance in 2007 and 2008, the researchers said, noting that traumatic brain injury is a "significant cause of death, disability, and health care use among U.S. children."

Knowing the extent and outcomes of such injuries, they added, would be useful to target and test prevention measures, among other things.

To help clarify the issue, the researchers are conducting a study of longer-term disability among children with traumatic brain injury. As part of it, they developed a population-based surveillance system in King County, Washington, which consists of Seattle and its suburbs.

Over the surveillance period in this report, from April 1, 2007 t0 Sept. 30, 2008, they recorded 1,333 children with traumatic brain injuries in a subset of the area's hospitals. Extrapolating to the whole region led to an estimated 1,805 children seen for such an injury, they reported.

Koepsell and colleagues found:

The overall incidence rate was 304 cases per 100,000 child-years.

Rates for boys were greater than for girls in every age group, and overall were 387 per 100,000 child-years for boys (ages 0-17), compared with 218 for girls (ages 0-17).

The relative risk for boys versus girls increased with age -- 1.35 for those 4 and younger; 1.68 for those 5 to 9; 2.39 for those 10 to 14; and 2.41 for those 15 through 17.

Children 4 and younger had the highest incidence and those 5 to 9 had the lowest incidence -- 421 versus 213 cases per 100,000 child-years, respectively. Rates rose again for older children.

Mild injuries were most common, with an incidence of 296 cases per 100,000 child-years compared with 7.6 cases per 100,000 child-years for moderate, severe, and fatal injuries combined.

The mechanism of injury varied markedly with both age and sex, the researchers reported.

For both boys and girls 4 and younger, injury resulted most commonly from a fall. On the other hand, injuries that resulted from being struck by, or against, an object rose steadily with age among boys, but not girls.

Injuries linked to motor vehicle accidents were more common among older children, Koepsell and colleagues found, while injuries linked to bicycling were most common among those ages 10 through 14.

The researchers cautioned that their data don't capture injuries in which no medical aid was sought, or in which treatment occurred outside emergency departments.

As well, they noted, local environmental and sociodemographic characteristics may limit the extent to which the findings can be applied elsewhere.

The study was supported by the CDC. The authors told the journal they have no relevant disclosures.

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